Endoscopic Endonasal Approach for Tuberculum Sellae Meningioma

"Endoscopic Endonasal Approach for Tuberculum Sellae Meningioma"

Juan C. Fernandez-Miranda, MD, Carlos Pinheiro-Nieto, MD, Paul A. Gardner, MD, and Carl H. Snyderman, MD
Departments of Neurological Surgery and Otolaryngology, University of Pittsburgh Medical Center

Here we present the technical and anatomical nuances needed to perform an endoscopic endonasal removal of a tuberculum sellae meningioma. The surgical anatomy of the suprasellar region is reviewed, including concepts such as the chiasmatic sulcus and limbus sphenoidale, medial and lateral optico-carotid recesses, and the paraclinoidal and supraclinoidal segments of the internal carotid artery. Emphasis is made in the importance of exposing the distal dural ring of the internal carotid artery and the precanalicular segment of the optic nerve for adequate intradural dissection. The steps for reconstruction are detailed, and include intradural placement of dural substitute and extradural placement of the nasoseptal flap. The nuances for proper harvesting, positioning, and reinforcement of the flap are described. No lumbar drain was used.